Tag Archives: Midwifery

Epidurals, Opioids and Nitrous. Oh My!

One of the wonderful parts about being a human family made up of unique individuals is that we are all different. We go to different jobs, we love different people, we experience a rainy day differently. How neat is that? We have a daily opportunity to embrace each other for the quirks and choices that make us each special. And when I put it that way, it seems easy to do. Where we get hung up is in thinking that someone else’s preference is better or worse than your preference. This can lead to feelings of superiority and resentment, neither of which help us celebrate each other’s differences.

This is true in day to day conversation. If I learn that you like olives (which I despise*), I don’t have to say, “Olives? YUCK.” Instead I might try, “Great! More olives for you, then!” You liking olives is not an affront to the fact that I dislike them so I shouldn’t feel compelled to express my disgust, after all this isn’t about me. And surely a two person divergence on briny foods has a relatively low impact on the way we relate in society, but it doesn’t stop there.

*seamless segue to women’s health*

Women (or those with vaginas) be they trying to prevent pregnancy, decide how to proceed in pregnancy or manage the pain of labor, have a Las Vegas-style buffet of options available to them (and I would like to keep it that way, but that’s not the subject of this post). From pills to implants to shots to little T-shaped pieces of plastic or metal, women have choices when it comes to birth control. To all of them, I say yes. You like taking pills every day? Good for you. You want to never have a period again? Also an option. I would never recommend my chosen form of birth control to anyone, because it’s ridiculous, and this isn’t about me.

I talk to pregnant women all day about how they plan to manage the pain of labor and, surprise! They all have different answers. Some plan to do hypnobirth, others hypnobabies (not the same thing), some want to try nitrous oxide, others plan epidurals and, guess what? They all have babies at the end. It’s not a contest and the prize is the same for everyone. Most importantly it doesn’t matter what I think about how a mother chooses to experience her birth because, you guessed it, still not about me.

And it’s not about you either. And neither is a woman’s decision to breastfeed or bottle feed or stay home with her children or to go back to work. Immunizations are about all of us, but more on that later. As for now here is an infographic of what I think is the best way to present information: here are your options and I will support your choices. That’s my job.

Source: The Parent College

*Olives are delicious. Anyone who says differently is 5 years old.

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Chicken Poop for the Soul

Hear me out…

Vanderbilt nurse-midwifery students are strongly encouraged to attend the ACNM (American College of Nurse-Midwives) Annual Meeting, which will be held in Chicago this year. Because this is optional we have to pay for it ourselves and some of the more industrious students have fundraised by selling felt vulvas, which are amazing, but far beyond the reach of my creativity. Whilst hiking with one of my colleagues, the topic of bowel movements came up. When you spend all day talking about vaginas and looking at cervixes, nothing is really off limits. We were sharing the stories our of most memorable twosies when, bam! I was hit by a stroke of genius.

What if I interviewed my friends and colleagues about their most distinguished bowel movements and then compiled them into a book of short stories? It would be perfectly sized for the back of a toilet and each entry expertly written to be enjoyed during one’s morning constitution.

Guys, it’s a book about poop to read while you’re pooping. Who wouldn’t want that?

After strongly considering dropping out of school to pursue this goldmine of a business venture, I decided I could probably do both. The working title for this project is Chicken Poop for the Soul because I received a cease and desist letter from Walt Disney when I floated the idea of Winnie the Poop by my social network.

I’m now accepting submissions so don’t miss your chance to be a part of this groundbreaking opportunity. Chicken Poop for the Soul will revolutionize your bathroom experience much like the Squatty Potty has. Your participation and/or purchase will help send a student midwife to an expensive conference she has been asked/bullied into attending.

Now as a reward, and because I’m deeply committed to dropping knowledge, among other things (see what I did there?) please enjoy this pictorial representation of the medically-recognized categories of feces. Poop on, Wayne.*

BristolStoolChart.png

*NBC has asked me to refrain from using this phrase, but I say come at me, bro.

Submissions accepted at leacraftspencer@gmail.com

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Holidays, Laughter and Foreskin: The Fundamentals

The back to school or work adjustment is always a challenge post-holidays. On the one hand, people are often invigorated with big plans for new year, which is adorable. On the other hand it’s cold and, in my case, lonely and trying to get back into a routine after time off can be a little bumpy. Everything you had delegated to future you is now present you’s problem and I always have more faith in future Lea than she really deserves. But in any event, here we are. Mostly due to excessive aforementioned faith in my future self, my past self decided that my partner and I should visit three states in the 10 days he could reasonably be expected to take off work for the holidays. Fun!

So, we did it: Texas for Christmas, Florida for Hanukkah and New York for New Years. It was as crazy as it sounds but totally necessary and worth it. We had recently seen the family we have in Arkansas and California, but the Floridians and New Yorkers had yet to see the whites of our eyes since we became a married couple. Our jaunt included planes, trains and automobiles, Texas BBQ, Florida beaches and Times Square on New Years (just kidding, only a crazy person would do that). Our hearts and stomachs were filled with love, pizza and bagels and before we knew it was back to reality, whoops there goes gravity.

School has been back for a week now and this year marks the start of my clinical rotations as a midwifery student. It reminds me a lot of my first rotation as a nursing student with all the fumbles, missteps and fear. I had the great pleasure of enjoying dinner with some of the colleagues I shared my very first nursing rotation with and the laughs we had while reminiscing reminded me of the post-rotation conferences we had when we were all still learning to listen to hearts and lungs.

I always consider the beautiful souls I went through undergrad with to be kindred spirits from whom I can never really part. The impact of nursing school has bonded me to some of these people in a similar way. The image of being surrounded by my male colleagues outside the room of a patient whom I was about to catheterize is forever burned in my memory.

“Is he circumcised?” they asked.

“I’m not sure,” I replied. My preceptor then asked if I had ever seen a foreskin, to which I quickly replied, “I really don’t see how that’s any of your business.” We were off to a great start. Ultimately the procedure was successful, but there was and is always one thing to do in nursing school before you are allowed to call it a day: reflect.

In keeping with the tradition of reflection, I shared my experience of the catheterization with my group. Specifically, I highlighted my surprise at how profoundly I was able to feel the catheter in my hand through the patient’s penis. I looked at one of my colleagues, a woman I admire more than most on this Earth and admitted, “I guess I’ve just never held a flaccid penis before.” Without missing a beat this incredible woman facetiously replied, “Well, good for you!”

It was the best day of my life.

Any day that comes anywhere close to feeling as connected as I did to those people during that rotation will be an opal in a week of dumb, stupid rocks. Here’s to hoping we all continue expanding ourselves with people we can have a really good belly laugh with; I’m convinced those are all that really matter in this world.

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Placenta. Enigma. Namaste.

The placenta is a confounding element of labor and delivery. Giving birth to a brand new entire person is largely hailed as the single most challenging and unifying event humans undertake (along with death, but more on that later). This monumental feat comes after growing this would-be human INSIDE of you, which – let’s be honest – is pretty bananas. So after 40ish weeks of gestation and who-really-knows how many hours of labor, you have a baby!

But, it’s not over yet.

Now comes what we refer to as the 3rd stage of labor, a part so important it had its own category: delivery of the placenta. This new organ is something you grew before the belly fruit began to resemble anything other than a seahorse (yes, offense). The placenta makes good use of all the extra blood you’ve been pumping around (up to 50% more in fact) as it transmits nutrients and oxygen to the fetus and acts as filter for bacteria and other unsavory characters you’d prefer your child waited until daycare to meet. Its delivery has to be carefully attended to because any retained pieces can cause serious problems for you and ain’t nobody got time for that – you’ve got a baby now! So once this blood filled, brain looking, much-bigger-than-you-thought-it-would-be thing is delivered and examined, what do you do with it?

I’m glad you asked.

The placenta is a mystifying entity that different cultures hold in various high regard. Some groups believe it has a spirit of its own and must be buried near the family house as a guide of sorts. This doesn’t seem so strange to me – it has to be gestated and born along with the baby, and without it, baby would have never made it this far. Other cultures use it more practically as fertilizer – all hail the pragmatist. Companies have been built around their ability to encapsulate it so that you can eat it; preesh you, capitalism. And, of course my favorite, carrying it around with the baby until the umbilical cord (along with the placenta) dries up and detaches on its own: the lotus birth. A majority of westerners do nothing with it and it is incinerated (BOR-ING).

As with most things in birth, to all of these options I say yes. Women need to support other women as we navigate the veritable cornucopia of options available to us.

And now, a picture. Because in 2017, infographics and nihilism will be the only truth.

Source: National Institute of Health

 

Lotus birth, even though we both know you already Googled it.

Source: MJY 

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Midwifery FAQ

1. What the hell does 6cm look like?

Sure, I could pull out a tape measure and treat you like an adult, but instead please direct your attention to this gross chart so I can fulfill a childhood dream of mine by comparing your cervix to a bagel (which, by the way, vary in size greatly).

Source: Sweet Leigh Mama

2. Why is the midwife always squeezing my tummy? And who is this Leopold?

Christian Gerhard Leopold (24 February 1846 – 12 September 1911) was a German gynecologist who developed these four maneuvers for determining the position of the fetus in the uterus. They are used by midwives to assess for a breech presentation (feet or butt first) and to estimate the size of the growing fetus.

Source: Wikipedia

3. Oh, you’re going to be a midwife? Is that better than a doula?

Well, that’s like asking if a pilot is better than a flight attendant. It’s not wrong, it just means our profession needs a better PR department.

But yes, I’m also a doula — many of us are.

Source: Ancestral Wellness Temple

4. Why is my baby covered in cheese? No, I don’t want to touch it. You touch it!

Vernix is an expected finding on a newborn and its benefits (along with thermoregulation) are part of the reason the WHO recommends that baby’s first bath be delayed at least 6 hours (and ideally 24h).

Sidebar: Has anyone checked out The Alternative Mom, from whom I stole this photo via the Pinterest? She sounds feisty.

Source: The Alternative Mom

5. What exactly is the difference between a vagina, a cervix and a uterus?

More than you’d think! If a female person is standing up, the vagina is closest to the ground and is accessible through the middle of the three openings that persons with two X chromosomes typically have.

The cervix is the (normally closed) canal that leads to the uterus and becomes thinner and more open during labor. Ask to take a look the next time you have a pelvic exam or check back here soon for a series I’m working on called Guess Whose Cervix?*

For more info on the cervix, check out this great post on Across The Speculum.

The uterus is the uppermost cavity where tissue builds up every month to either support a fertilized egg, be shed during a woman’s period or be safely reabsorbed if she is on progesterone-only contraception (more on that later).

For now, this:

Source (and on sale now): Blue Barn House Store

*currently accepting photos for this series at leacraftspencer@gmail.com

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Certified Nurse Midwife: Huh?

I wait tables in Nashville from time to time and am often caught explaining to people what I really do. Servers love this question because it manages to be invasive and critical at the same time. On one such occasion I was explaining to the stranger who had inquired that, in addition to supporting myself by waiting on people like her, I was a nurse and studying to be a midwife. She became very excited and said, “Oh, wow! My niece is doing the same thing. Oh, no… wait.. No, I’m sorry, my niece is going to be a nanny.” Now, I’ve answered an impressive range of questions about what a midwife is, how it is similar to a doctor and how it differs from a witch. But this genuine mistaking of a midwife for a nanny has been by far the most amusing.

Nursing school is a bubble land and it can be very difficult to remember how little the public really knows about advanced practice nursing. This is partly because the profession is evolving and has been for the past several decades, but it’s also because the general public doesn’t really care where their healthcare comes from — which is fine. It’s my job to know how to be a midwife, but it’s also important to offer digest-able knowledge to people when they want it (if only for the survival of our trade). To that end, I went digging for some straightforward definitions of what a midwife is and came across this infographic from 2010.* Some of the information might be a little dated, but I think it breaks it down pretty well. What do you think?

 

Infographics: making complicated concepts simple enough for you, me and everyone we know.

(Source: Scrubs Magazine)

*That’s a lie — I was looking for giggle-worthy memes and found this by accident. Whew, felt good to get that off my chest.

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Peer Pressure, I’m very sensitive.

It has been a minute since I’ve used this space but two of my best friends have recently taken to the social media and now I’m gonna, too! Their excellent writing has impressed in me the importance of using the online to spread information about women’s health. Please check out this great blog: https://acrossthespeculum.tumblr.com/ and follow this twitter feed: @southern_stdtNM. These are two brilliant women who inspire me to be more but make me feel like I’m enough. It’s possible that I will write some about women’s health, but no promises.

A lot has happened since I’ve been away. We lived in Carolina while Jared did the MBA thing and then we backpacked around South America for a few months (cause when else are we going to have the time?) and now I live in Nashville where I’m studying to be a midwife (what?) and Jared lived in Seattle, where he works for Amazon. We also exchanged sarcastic nuptials in a bar last March. Mazel to us.

But back to being a student midwife and all the amazing women I get to grow into this role with. After spending a year becoming an RN, which included spending time with a lot of 22-year-old blonde women, I am proud to call one or two of them my friends. My other comrades in this program are older, wiser and more brunette (although the true geniuses among us remain defiantly blonde). We are a motley crew of individuals from all over the country with different goals and opinions about women’s health. How great is that?

Our group runs the gamut. We have die-hard liberals eager to take issue with the status quo as well as southern conservatives whose norms are being challenged. I believe the breadth of experiences each of us bring makes all of us better. Our differences are representative of the wide range of women we will be serving, all of whom deserve health care providers who will advocate for their wants and needs.

A brilliant friend once said, “If I’m ignorant about something don’t belittle me, educate me.” This knife cuts both ways because I know firsthand that liberal New Yorkers are just as capable of being closed-minded as conservative Texans. Being truly able to embrace newness without judgment is a skill I have yet to master, but it’s one I aspire to. We have only to gain from being open to learning from people who are different from us. It’s when we think we’ve figured it all out that we’re really missing opportunities to grow.

This program has shown me both that I know nothing, Jon Snow, and that I’m capable of literally anything. We all are. In 18 months Vanderbilt has turned 140 students, some fresh of out undergrad, into nurses on their way to becoming NPs. What’s an NP do again? They help the doctor, right? And midwives – are they really still a thing?

In a nutshell, a nurse-midwife is an advanced practice nurse just like a nurse practitioner. A nurse practitioner is an independent health care provider who can work with or without doctors in a variety of settings. Other types of nurse practitioners include those who work in primary care, those who work in acute care (the hospital), those who just see kids, those who just see older folks and those who specialize in mental health. 95% of CNMs (certified nurse midwives) work in hospitals attending vaginal births and our scope of practice includes primary care for women from puberty through menopause.

Pelvic exams, STI testing, contraception prescribing, IUD insertions, prenatal care, labor and birth support, sexual health needs, menopause symptom management — midwives do it all.

The more you know.

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